What price mental health? part II

The overall piece is on the literal and figurative costs of bipolar disorder: getting to sanity, staying sane while parenting, and raising a child with a high likelihood of inheriting the tendency. Part one, the preamble, is here. Part two covers the actual dollar costs of getting me to stable; I have limited it to a particular time period in my life during which my primary focus was on my own (mental) health, although if I traced the journey from beginning to end there would be years added on, with the potential for a case being made to count my entire birth to now; that, however, would not be as readily calculable. Thus, the following is about the years 2002-2005, when The Man and I lived, for various reasons, in the middle of America, far away from anyone and anything we knew.

The things it took to bring me from hell to now (not heaven, but the glorious mundanity of earth) were: talk therapy; psychotropic medications; massage therapy; acupuncture; lots and lots of fish oil; and lifestyle and thought pattern and dietary changes too numerous and subtle to list here (arguably the biggest and most important of those: regular and regulated sleep, which is one of the many reasons new parents whether biological or not are at risk for PPD and other postpartum disorders). It took several years, and a hell of a lot of work, and ultimately required moving across the country out of a psychic-black-hole cesspool of a house and to a city where my heart sang “Home!” to get to a real, lasting, joyful stability.

And it cost a lot of money.

How much money exactly? First, I should point out that because of where we were and how I was doing, my parents financed all of this. There is simply no way I could have done any of this without them; I could probably not afford to do it all even now. The privilege in having parents who were able and willing to do this for me is breathtaking and humbling. I was blessed to be the late-born daughter of doctorate-holding, career-stable, mortgage-paying, middle-class, married white American parents who are mental-health knowledgeable and alternative-therapy-tolerant. If not for them and for their multiple states of privilege, I simply would not have been able to spend those years pursuing health and stability in the way I did, and would likely not be sane today. It is privilege, pure and simple, that allowed me to, via my parents, afford these things. It is criminal that so many do not have the financial or social access to resources that my privilege granted me. I take none of this for granted. (Conversely, at least a significant portion of these costs could have been avoided with even a rudimentary Universal Health Care system in place. If that be socialism, than socialist I be.)

And now, in the honor of American tax time, an itemized list, primarily covering the years 2002-2005 (unlike the IRS, I do not expect an audit; numbers are rounded and approximated for ease of calculation):

First, there was the health insurance, which you will see did not do much to pay for the things that got me to wellness, but was viewed as necessary by those around me; to be sure, we would all have been grateful for it should a hospitalization ever have proven necessary. The first year or so I was still, barely, able to be on my parents’ employer subsidized insurance, at probably $75/month (did I mention they had good jobs?). The next two years they paid for COBRA coverage for me, at approximately $400/month, after which I had no insurance. Total cost: $10,500

There was the psychotropic medication, a “premium” formulation new enough it was not on my insurance’s preferred formulary, but considered worth it because I only had to take it once a day, and had more flexibility in timing its ingestion without incurring negative effects. I was on it for approximately the same three years I had health insurance, at $80 every three months. Sub total: $640. There were also numerous blood draws and psychiatric visits for medication management, not all of which were covered for one reason or another (my medication cessation management was overseen by a DO, after I lost insurance, with whom each visit was over $100), and a brief (comparatively) stint on an additional antidepressant medication and the attendant psych visits. So, let’s call the total an even $1000.

When medication alone proved not to be sufficient, I was recommended by a college adviser to see a psychologist known for his quirky humor and Buddhist-influenced woo-ish talk therapy, with particular experience with bipolar spectrum disorders. We were, indeed, a good fit, and I saw him nearly every week for those four years; the attempt to switch to every two weeks proved problematical, as did the attempt to switch therapists. He charged $100 per 50 minute session (he actually raised it $5 every calendar year I saw him, and was due to hit $115 when we moved back across the continent; conveniently averaging $100 for the four years I saw him). And my insurance did cover him, with only a $15 copay… for the first 22 visits a year. Copay subtotal: $1000. Out of pocket total: $14,400.

Counterpoint to talk therapy was massage therapy; massage grounded me, tethered me to reality and the body and the now at times when I felt like flying right out of my skin. It also helped me learn to accept and love my body again, after side effects of the medication made me feel it had betrayed me. I was blessed to have first one and then another excellent massage therapist, each of whom was willing to offer me amazing deals that amounted to $100/month for biweekly or semimonthly massage. Times three years (2003-2005), that totals: $3600

Acupuncture I started a year after massage therapy, on alternate biweeks from the massage; with offering me a student discount, even though I was primarily studying myself at that point in my life, sessions were $40 each, a bargain when his sessions were 1.5-2 hours, and we have yet to find another acupuncturist who holds a candle to how caring, involved, respectful, informative, and effective he was. Total cost: $1900

What finally clicked for me (although it could not have worked without all the rest of it) was high omega 3 (specifically EPA 50% by weight) fish oil. I had heard bits about it in terms of mental health before, but was convinced to start trying it based on a metastudy published in a peer-reviewed psychiatric journal that showed high EPA was as or more effective than standard psychiatric medications for mild to moderate cases of bipolar disorder, depression, bipolar depression, and even schitzophrenia. I started taking it a year or so before getting off the psychotropic mood stabilizer, and finally felt what I imagine the prescription was supposed to feel like: real mood stability and uplift. This is hardest to calculate, because my dose has fluctuated so much over the years, from as little as 2 caps to as many as 8 a day. My most common dose, though, was 2g twice a day; thus, at $15 for a 90-capsule bottle (purchased online at 50% discount off the $30 retail price), over two years, totals $500.

There were many other pieces to bridge to sanity I built, but though not without cost, they are harder to put a price tag on: getting regular and regulated sleep (8-10 hours, every night, no exceptions, which at times meant turning down concerts with friends, trips to big cities, and all of my night-writing, which is previously when I’d gotten the bulk of my inspirations); learning to listen to and trust my body, and eating foods that truly nourished me; avoiding anything that encouraged the mind-fuck mentality, which is pretty much all American media (and most Americans); avoiding artificial additives as much as possible; and avoiding subjecting myself to unnecessary stressors in all forms, from full time regular employment to countless well-practiced thought patterns. Did I mention it took a lot of work? But that was largely of the emotion-work category, which we are oh so good at avoiding in our calculations of Gross Domestic Product, so we’ll leave those out of these numbers (how does one count the cost of taking an hour to go outside and connect with the dirt for a while? it was on a doctor’s orders, but somehow I don’t think I could bill my insurance for it).

Grand total of the pieces easy to quantify: $31,900.

$31,900

For my international readers, that’s 25213 Euro, 22569 GBP, 41080 CAD, or 49754 AUD, in today’s currency at least (converter found here). That’s more than The Man’s mother grossed in an entire year, even right before retirement, after 20 years at the same job as a nurse’s aide. Then again, it’s only one base-price luxury compact SUV. It’s half of what the mortgage on the hell-hole house was, two-thirds of what we sold it for.

It’s a lot of money.

Some of these numbers have been very hard for me to type. $14,400 to sit in a room and talk to a guy for an hour once a week (total talk time: 200 hours)? Seriously? And yet, it was invaluable in terms of my mental health. Many weeks I walked out wondering what the point of it was; but each week, little by little, with leaps forward and setbacks suffered, life got better. Weeks I decided I didn’t need it, it wasn’t “doing anything”, and didn’t go in, were the hardest weeks to get through.

Maybe I could have, should have, gotten that therapy free from a 12 step program (which one, though? I had avoided most of the addictions commonly used to self-treat bipolar disorder, such as alcohol, drugs, sex, and shopping. where in that small town was the 12 step program for the woman who had everything and could do nothing? for moody artistic introspective types who didn’t plan or attempt suicide, nor cut open her flesh, but found getting a nice rhythm going with her head on the wall quite soothing? there may be a hundred AA-inspired groups out there, but some niches are yet to be covered), but this was what was available, this was what worked for me.

To own those numbers without hesitation or reservation, I have to be able to say, at some level, I am worth it. And I am. But even 200 hours of therapy hasn’t made that easy for me to proclaim, when everything in my culture tells me different.

How hard is it to admit to this much privilege? Very. (About $31,900 hard?) I could not have afforded this on my own. The Man’s mother, even if she were alive and still working at that time, couldn’t have afforded it. My own parents, after a long illness and a stock market crash, couldn’t afford it now. The privilege of being supported, not having to work for my food or shelter, taking four years to work exclusively on my self and my health… it is profound.

Will we be able to afford this for the Boychick? Will he need it? I pray he won’t, and we will even so, but the thought terrifies me.

Scarier thought still: will I need it again? Will he be raised by a mother, not blessed with sanity paid for with privilege, but wracked with instability and unable to sufficiently treat it?

cont. in part III